Page 143 - ACCCN's Critical Care Nursing

120 P R I N C I P L E S A N D P R A C T I C E O F C R I T I C A L C A R E

nosocomial infection, with feedback to critical care staff,
helps to improve compliance with infection control TABLE 6.13 Preventive measures to reduce the spread
guidelines. 119,124 In the 1980s, a landmark study estab- of gramnegative infection 128
lished that hospital-acquired infection may be reduced by
around a third if surveillance and prevention programs ● Identifying the infected patient using a colour-coded plate
are implemented. 125 according to the microorganism
● Infection control notification in the patient’s records
● Hand washing with antiseptic solution before and after contact
PREVENTION with the patient
The Australian government Department of Health and ● Contact precautions using obligatory gloves and gowns during
direct patient contact
Ageing provides guidelines for infection control within ● Separation of stethoscopes, sphygmomanometers and
119
the healthcare setting (see Box 6.3). All health services thermometers for individual use
should apply these guidelines and operate within clearly ● Separation of other articles and equipment for exclusive use of the
defined infection-control procedures, which are based on patient
Standard Precautions. Although formerly referred to as ● Daily surface cleaning and disinfection with 70% alcohol
Universal Precautions and Additional Precautions, the
recent guidelines on infection control from the NHMRC
uses Standard Precautions and Transmissions-based Pre-
cautions respectively to clearly describe these levels of
119
precautions. Critical care nurses should refer to their BOX 6.4 Hand hygiene: ‘5 moments’
specific hospital infection-control policies regarding
details of procedures that must be followed. Hand Hygiene is performed:
● before touching a patient
CONTROL ● before commencing a procedure
● after a procedure or exposure to body fluids
Once an organism has been identified, the goal is to limit ● after touching a patient
its spread. Although patients may be colonised with bac- ● after touching a patient’s environment
teria, they may not be infected. Colonisation refers to the
presence of microorganisms in any amount, whereas Plus
infection means that pathological tissue injury or disease ● after the removal of gloves.
has occurred due to the invasion and multiplication of Adapted from Grayson et al. 2009 117
the microorganism. 126 Typically, surveillance measures
identify many patients who are colonised with MRSA or
VRE, and although they themselves are not infected it is
important to stop the spread of bacteria to patients more hand hygiene compliance is poor, 119,120 but it can be
vulnerable and thus more susceptible to opportunistic improved significantly if regular education programs,
infection, by implementing Transmission-based Precau- feedback and reminders are employed 119-121 such as the 5
tions. 127 In a study of multiresistant gram-negative bacte- moments for hand hygiene (see Box 6.4) created by the
120
rial infections in ICUs, several effective measures were World Health Organization (WHO) in 2009 which has
128
demonstrated, which are summarised in Table 6.13. been adopted for local implementation, such as Hand
121
Due to the vulnerable nature of critically ill patients, Hygiene Australia. Evidence has led to the current rec-
specific issues are described in more detail including: ommendation of using an alcohol based hand rub for
hand hygiene, personal protective equipment (PPE), hand hygiene unless the hands are soiled. 120,121,129 The use
multi-resistant organisms (MROs), Healthcare associated of alcohol hand rubs is associated with higher rates of
infections (HAIs), ventilator associated pneumonia (VAP) hand hygiene compliance and effectiveness although
and central line associated bacteraemia (CLAB). effectiveness is dependent on technique. 120,121,129,130

Practice tip Practice tip

When using open tracheal suctioning techniques, it is most Compliance with local protocols for surveillance, isolation and
important to ensure that the ventilator connection is not con- use of PPE for MROs and infectious conditions is vital to the
taminated during the procedure while disconnected from the management of all patients, and the safety of personnel and
tracheal tube. visitors in critical care units.

Hand Hygiene Personal Protective Equipment (PPE)
At the core of Standard Precautions is effective hand PPE may include any and all of the following: plastic
hygiene. Good hand hygiene is a simple yet effective aprons, gowns (single use or sterile), gloves (single use or
technique that reduces the spread of bacteria. It is the sterile), masks ranging from surgical to particulate filter
most effective and least expensive method of preventing N95 mask or P2 respirators and eye protection such as
120
healthcare associated or nosocomial infection. However, goggles or face shields that also protect mucous